Background: Decentralisation aims to bring services closer to the community and has been advocated in the
health sector to improve quality, access and equity, and to empower local agencies, increase innovation and
efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji
has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration
of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision.
Methods: Using a modified decision space approach developed by Bossert, this study measures decision space
created in five broad categories (finance, service organisation, human resources, access rules, and governance
rules) within the decentralised services.
Results: Fiji’s centrally managed historical-based allocation of financial resources and management of human
resources resulted in no decision space for decentralised agents. Narrow decision space was created in the
service organisation category where, with limited decision space created over access rules, Fiji has seen greater
usage of its decentralised health centres. There remains limited decision space in governance.
Conclusion: The current wave of decentralisation reveals that, whilst the workload has shifted from the
tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative
authority, suggesting that Fiji’s deconcentration reflects the transfer of workload only with decision-making in
the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and
providers are likely to be limited
